Transcription

1 Multisector Collaboration One Health Approach to Addressing Antibiotic Resistance Nov. 5, 2015 The One Health concept recognizes that the health of humans is connected to the health of animals and the environment. ASTHO, with support from CDC, convened an invitational session, Multisector Collaboration One Health Approach to Addressing Antibiotic Resistance, to explore collaborative actions public health and agriculture partners can take to address the issue of antibiotic resistance. The meeting also continued the discussion from the National Institute of Animal Agriculture s (NIAA) annual Antibiotics Symposium to examine next steps for states to collect and analyze data and develop metrics. State Roles in Addressing Antibiotic Resistance At the NIAA Symposium, Tom Chapel, chief evaluation officer, CDC, presented a logic model that draws from the National Action Plan for Combating Antibiotic-Resistant Bacteria, as well as previous NIAA Symposium discussions. Participants had the opportunity to further discuss the logic model in small groups at the ASTHO meeting and to provide input on which activities and outcomes would most benefit from state involvement. For states, participants identified roles in activities related to stewardship and surveillance, which can support National Action Plan Goal 1 (Slow the Emergence of Resistant Bacteria and Prevent the Spread of Resistant Infections) and Goal 2 (Strengthen National One Health Surveillance Efforts to Combat Resistance). For example, participants identified a state role in the activity labelled identify and educate on best stewardship practices. If this work is done collaboratively with public health and agriculture partners, it can lead to the outcomes of strong antibiotic stewardship in human healthcare and strong antibiotic stewardship and veterinary oversight in food production and animal husbandry. There is also a state-level role in integrated, One Health surveillance; participants indicated that analyzing and interpreting surveillance data could benefit from public health expertise. Participants concluded that information sharing between state public health labs and veterinary labs could be improved. A minimum data set might be created to share data between settings and track the movement of resistance to target interventions. States can also have a role in the activity labelled mobilize, advocate, and engage across sectors to lead to the outcome of more regional cross-sectoral cooperation. Participants noted that public health engages in activities, such as outreach and education to the public, with the goal of changing public perception of antibiotics. There is sometimes a disconnect between public perception and science-based information (e.g., fluoridation, pasteurization); the state role in public outreach has the capacity to affect public perception of the importance of antibiotic resistance and judicious use. State-level One Health Approach to Addressing Antibiotic Resistance One meeting objective was to explore next steps for joint leadership and collaboration among public health and agriculture at the state level to address antibiotic resistance. One Health is a strategically important concept for moving this work forward, and a state-level One Health Committee can coordinate a multisector approach. Ideally, a One Health Committee would have a dedicated, funded leader.

2 Funding While states may not currently receive dedicated funding for One Health coordination and activities, they can map One Health concepts to relevant funding sources to identify potential small amounts of seed funding. Potential funding sources identified by the group include CDC s Epidemiology and Laboratory Capacity cooperative agreement, CDC s Public Health Emergency Preparedness cooperative agreement, FEMA grants, USDA funding, or Preventive Health and Health Services block grants. State public health and agriculture departments can also partner on One Health activities with external groups that are receiving relevant funding, such as hospital associations or quality improvement organizations. Engaging Partners Several states provided examples of past or ongoing work to engage relevant partners in One Health efforts, either specifically around antibiotic resistance or more broadly. Two examples are highlighted below. Tennessee previously received funding from CDC s Get Smart on the Farm initiative and used it to support the Tennessee Team on Antimicrobial Resistance. Partners included the state veterinarian, state public health veterinarian, Tennessee Cattlemen's Association, University of Tennessee College of Veterinary Medicine, and the cooperative extension program. The team worked with the USDA National Agricultural Statistics Service to survey beef cattlemen, support changes to the Beef Quality Assurance program, and present on stewardship to partners. If continued funding had been available, the next step would have been a survey to assess knowledge. This work was successful due to partnerships based on trust. Georgia has convened a group to develop a plan in case highly pathogenic avian influenza afflicts the state. The Georgia Departments of Public Health and Agriculture are involved, along with other partners such as USDA, Georgia Poultry Laboratory Network, University of Georgia College of Veterinary Medicine, Cooperative Extension Service, Georgia Poultry Federation, and poultry industry partners. This group could possibly transition to discuss antibiotic resistance and stewardship. They also engage in multi-agency collaboration and planning around potential bioterrorism or large-scale zoonotic disease events (related to BioWatch). Georgia has found it can be difficult to keep this cross-sectoral work moving, and that such efforts would benefit from having one dedicated position to work between the departments of public health and agriculture. Throughout the discussion, meeting participants raised other partners to include in a state s One Health collaborative efforts to address antibiotic resistance, including: One Health Commission Farm Foundation Farm Bureau Beef Council Cooperative extension Medical or veterinary students Environmental Health Association of Public Health Laboratories

3 In addition, participants suggested engaging state veterinarians and HAI coordinators to identify other relevant partners. Data Collection and Analysis Antibiotic Use and Resistance The group discussed considerations and priorities for collecting and analyzing data. Data collection requires resources, so it is important to ensure the antibiotic use and resistance data collected can be used to inform action. Data can be used to evaluate the effects of federal guidance or state initiatives to ensure they are being adopted as intended, to provide greater transparency regarding antibiotic use practices in food-producing animals, and to inform understanding of how antibiotic use practices may be associated with resistance. Needs Baseline data and information on normal variability to determine trends in resistance. o e.g., for animal populations, data on the proportion of isolates resistant/susceptible from different animal commodities at different stages Information on indications for antibiotics given to animal populations. Standardized way to compare resistance across human and animal populations demographics, minimum inhibitory concentrations (MICs). Data sharing across human and animal settings. Understanding of how antibiotic resistance is transmitted in the environment. Data Sources FDA and CDC have released extensive information publically through the National Antimicrobial Resistance Monitoring System (NARMS) that can be used to identify trends but that data is not timely. Veterinary Feed Directives (VFDs) could be a potential source of use and indication information. VFDs are managed by veterinary boards and can be paper or electronic. Specific information is included on sample submission forms for veterinary laboratory analysis. The requirements under the new California law present an opportunity to collect baseline data and perhaps pilot concepts to see impact. State Example California Law on Antibiotic Use in Livestock California recently passed a law (SB27) that codifies FDA Guidance for Industry #213 and provides additional context and requirements, such as defining allowable prevention uses of medically important antibiotics for livestock. It requires the California Department of Food and Agriculture (CDFA), in consultation with partners, to develop antimicrobial stewardship guidelines and best management practices and to gather information on drug sales and usage, resistance data, and livestock management practice data. CDFA is currently determining implementation strategies and actions and sees a role for meeting participants to help inform implementation planning. It sees a strong opportunity to learn from stewardship efforts in human settings. CDFA also plans to ensure the information it collects is useful to producers so the producers have incentive to share data and make progress. The department plans to work collaboratively with producers to enhance transparency so the producers stewardship efforts are shared with the public.

4 State Example Washington State One Health Surveillance Washington State s One Health Surveillance and Data Systems Workgroup is looking at integrating antibiotic resistance data. It is working to collect information from various data sources, but access can be complicated. The workgroup is trying to access and compile state-level data collected through NARMS (animal isolates through USDA, retail meat through FDA, and human isolates through CDC). It also will collect data on companion animals from the Washington Animal Disease Diagnostic Laboratory and private labs. The workgroup s initial focus will be on E. coli, but it intends to also collect data on Campylobacter, Salmonella, and MRSA. It plans to look at resistance across the state and similarities and differences across categories to gauge where to focus efforts. Analyze Use and Resistance Together To truly inform and evaluate action, the health community needs to analyze antibiotic use and resistance data together to see the impact of use on resistance. However, this is an extremely complex issue and there is not an ecologic model to map out the relationships between use and resistance. Changes in antibiotic use practices may prompt a shift from one type of resistance to another. Any data would take a long time to collect and would require funding (e.g., through academic research projects). Some suggestions for looking at use and resistance together include: Connecting antibiotic use patterns with identified resistance in the same geographic area. Linking pathogenic bacteria and antibiotic residues identified in processed meat at one source. Examining what is found in the environment (e.g., in wastewater). Stewardship Metrics Meeting participants discussed metrics for stewardship and judicious use in human and animal populations. One metric participants identified that would be particularly useful for tracking public health efforts to address antimicrobial stewardship involves assessing how many facilities or producers in a state have implemented core elements of a stewardship program. CDC has developed core elements for hospitals and long-term care facilities, and there are guidelines and quality assurance programs for stewardship for different animal commodities. Tools Meeting participants brainstormed tools that are needed and that ASTHO can help develop or support, including: Messaging/educational tools: how to communicate the One Health concept as it relates to antibiotic resistance and determine if there can be a common One Health messaging platform, with tweaks to target to specific audiences. Discussion board or group to share information, e.g., community of practice, learning collaborative. Information from the veterinary side adapted or translated for public health. Policy options or framework that include considerations from public health and agriculture. Next Steps ASTHO will continue to engage meeting participants, share best or promising practices, and develop tools to further this work. Additional information on ASTHO s antimicrobial resistance activities may be found on ASTHO s antimicrobial resistance website.

National Action Plan development support tools Sample Checklist This checklist was developed to be used by multidisciplinary teams in countries to assist with the development of their national action plan

The Third OIE Global Conference on Veterinary Education and the Role of the Veterinary Statutory Body was held in Foz do Iguaçu (Brazil) from 4 to 6 December 2013. The Conference addressed the need for

Antimicrobial Use and Antimicrobial Resistance in Relation to the Canadian Pork Sector Presented by Jorge Correa Pork Committee Banff May 2013 Part of the Slides were extracted from a Paul Dick presentation

Antibiotic resistance and the human-animal interface: Public health concerns Antibiotic Use and Resistance Moving forward through shared stewardship National Institute for Animal Agriculture Atlanta, Georgia

FMM/RAS/298: Strengthening capacities, policies and national action plans on prudent and responsible use of antimicrobials in fisheries Final Workshop in cooperation with AVA Singapore and INFOFISH 12-14

Antibiotic Resistance & chicken Chicken Farmers of Canada (CFC) supports the judicious use of antibiotics that have been approved by the Veterinary Drugs Directorate of Health Canada, in order to ensure

Challenges and opportunities for rapidly advancing reporting and improving inpatient antibiotic use in the U.S. Overview of benchmarking Antibiotic Use Scott Fridkin, MD, Senior Advisor for Antimicrobial

Addressing Antibiotic Resistance: Local Leadership Opportunities Antibiotic Resistance is a Problem Antibiotic resistance is one of the top five threats to public health. Antibiotic Resistance is a Problem

Antimicrobial Stewardship Preventing the Spread of Antibiotic Resistance and Improving Patient Care (Adapted from the Centers for Disease Control and Prevention) What is Stewardship? Antimicrobial stewardship

7 December 2017 Committee for Medicinal Products for Veterinary Use (CVMP) Committee for Medicinal Products for Veterinary Use (CVMP) Work Plan 2018 Chairpersons Chair: D. Murphy Status Adopted in December

What Canadian vets need to know and explain about antimicrobial resistance By John F. Prescott, MA, VetMB, PhD Major changes are underway regarding how agricultural use of antibiotics is regulated in food

Antimicrobial Resistance, yes we care! The European Joint Action Context of the Joint Action General objectives Inclusive governance Conclusion Context of the Joint Action 1. Context of this Joint Action

of Conferences of OIE Regional Commissions organised since 1 June 2013 endorsed by the Assembly of the OIE on 29 May 2014 2 12 th Conference of the OIE Regional Commission for the Middle East Amman (Jordan),

Options for a global development and stewardship framework to combat AMR Consultation of Member States and relevant partners Geneva, 29 February 2016 Peter Beyer Resolution WHA68.7 Requests the to develop

PLAYING CHICKEN WITH BUGS AND DRUGS: ANIMAL USE OF ANTIBIOTICS Gail R. Hansen, DVM, MPH Senior Officer The Pew Campaign on Human Health and Industrial Farming The Problem Antimicrobial resistance is one

Antimicrobial Stewardship: The South African Perspective Precious Matsoso Director General; National Department of Health; South Africa 13 th November 2015 Why do we need an AMR strategy and implementation

Project Summary Emerging Pathogens in US Cattle Principal Investigators: Jeffrey LeJeune and Gireesh Rajashekara Food Animal Health Research Program The Ohio Agricultural Research and Development Center

Mariano Ramos Chargé de Mission OIE Programmes Department Introductory presentation Regional Table Top Exercise for Countries of Middle East and North Africa Tunisia; 11 13 July 2017 Welcome to the Regional

Control and monitoring of the use of antibiotics as a strategy against antimicrobials resistance Christiane Santiago Maia ANVISA - Brazilian Health Regulatory Agency s Context The burden of deaths from

JANUARY 2018 COPING WITH ANTIMICROBIAL RESISTANCE REPORT 2 Friends of Europe January 2018 This is truly a global problem that can only be addressed by working together across the planet Tamsin Rose Senior

COUNCIL OF THE EUROPEAN UNION Council Conclusions on Antimicrobial Resistance (AMR) 2876th EMPLOYMT, SOCIAL POLICY, HEALTH AND CONSUMER AFFAIRS Council meeting Luxembourg, 10 June 2008 The Council adopted

Below please find the IDSA response to the Joint Commission s Proposed Standard for Antimicrobial Stewardship in various types of facilities, (AHC, CAH,HAP, NCC, and OBS). Comments are broken out by the

Office International des Épizooties World Organisation for Animal Health created in 1924 in Paris The Challenge of International Biosecurity and the OIE Standards and Actions Meeting of the State Parties

The Role of NGOs in Natural Disasters: Successful Disaster Management through Collaboration International Fund for Animal Welfare Kathleen Moore, 16 April 2015, Brussels Founded in 1969 15 Country offices

GHSA Meeting on Step towards Regional Strategic Collaboration in Asia-Pacific on Workforce Development, National Laboratory System Strengthening and Antimicrobial Resistance Prevention to Respond to Global

Wageningen Bioveterinary Research Biomedical and veterinary research to safeguard animal and public health Veterinary research to safeguard animal and public health Wageningen Bioveterinary Research (WBVR)

Jaipur Declaration on Antimicrobial Resistance We, the Health Ministers of Member States of the WHO South-East Asia Region participating in the Twenty-ninth Health Ministers Meeting in Jaipur, India, appreciate

Antimicrobial Stewardship in Food Animals in Canada April, 2016 This document was prepared by the National Farmed Animal Health and Welfare Council. The Council was formed in 2010 to advise governments

Providing Diagnostics to the International Veterinary Community MISSION The Texas A&M Veterinary Medical Diagnostic Laboratory (TVMDL) looks to engage entities in Latin America who share a common interest

Antimicrobial resistance Summary of OIE Activities July 2015 EDITORIAL Risks associated with the use of antimicrobials in animals worldwide Dr Vallat, Director General of the World Organisation for Animal

14 March 2017 (17-1466) Page: 1/8 Committee on Sanitary and Phytosanitary Measures Original: English/French/Spanish 68 TH MEETING OF THE SPS COMMITTEE COMMUNICATION FROM THE WORLD ORGANISATION FOR ANIMAL

2 nd Joint Conference on the Antimicrobial Resistance Action Plan (AMRAP) and the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI) 1. Background Antibiotic stewardship Implementing

AVMA Headquarters Externship Program Not every veterinary student envisions clinical practice as the goal of attending a veterinary college. Some students hope to teach, some to do research and some to

The Judicious Use of Antimicrobials for Beef Producers Introduction The production of safe and wholesome animal products for human consumption is a primary goal of beef producers. To achieve that goal,

Antibiotics and beef & lamb Gwyn Jones RUMA Chairman 8 December 2016 Who is RUMA? Unique initiative set up in 1997 Co-ordinated & integrated approach to best practice 25 organisations every stage of farm

Veterinary Legislation and Animal Welfare Tania Dennison and David M. Sherman Objectives of the Presentation Part 1 Brief background on the OIE Veterinary Legislative Support Program (VLSP) in the context

European Regional Verification Commission for Measles and Rubella Elimination (RVC) TERMS OF REFERENCE 6 December 2011 Address requests about publications of the WHO Regional Office for Europe to: Publications

Dr Gardner Murray, Special Adviser World Organisation for Animal Health (OIE) OIE activities on rabies: PVS, vaccine banks and the OIE twinning OIE Global Conference on Rabies Control: with the support

Guidance for Industry #213 New Animal Drugs and New Animal Drug Combination Products Administered in or on Medicated Feed or Drinking Water of Food- Producing Animals: Recommendations for Drug Sponsors